Menopause

Photo by: fotandy

Young girls start menstruating between the ages of eleven and thirteen,
when their reproductive systems reach maturity. Women have regular
menstrual cycles
every twenty-eight days until about the age of fifty, at which time
menstruation becomes irregular. This irregularity signals the start of
menopause
. The natural cessation of menstruation occurs due to reduced production
of the female
hormones estrogen
and progesterone, which generally occurs between the ages of forty and
fifty-five. The age at which a woman enters menopause is affected by
genetics
, race, and environmental factors. Women can also go into premature
menopause, either naturally or due to oophorectomy (the surgical removal
of the ovaries).

Stages of Menopause

Women go through different phases of menopause, including perimenopausal,
menopausal
, and postmenopausal periods. During the perimenopausal period, the
regular cyclical occurrence of menstruation is disrupted and menstruation
becomes irregular. This phase may last anywhere from six months to a year.
During the perimenopausal period, production of estrogen is reduced, and
eventually stops. Menopause is defined as the cessation of the menstrual
period. Women are described as postmenopausal when they have gone one year
without a menstrual period.

Physiological Changes

The lack of estrogen and progesterone causes many changes in
women's
physiology
that affect their health and well-being. These changes include:

Elevated levels of total
cholesterol
and LDL-cholesterol, which increases the risk of
coronary heart disease
(CHD) in women. During the reproductive years, estrogen prevents
increased levels of blood cholesterol and maintains the activity of
estrogen receptors in women, thus preventing the risk of CHD.

Calcium
loss from the bones is increased in the first five years after the
onset of menopause, resulting in a loss of bone density. This bone loss
then tapers off until about the age of seventy-five, when calcium loss
accelerates again. This predisposes women to the risk of
osteoporosis
and bone fractures.

The body composition of menopausal women also changes, with the
percentage of body fat increasing and muscle mass decreasing. The
increase in body-fat percentage is believed to be partly due to
decreased physical activity.

Decreased muscle mass reduces the rate of
basal metabolism
, which may be responsible for weight gain at this period of a
woman's life.

The abdominal-fat storage that occurs in women at this stage increases
the risk for
cardiovascular
disease.

The tissues in the urinary tract and reproductive organs atrophy.

Some other transient but unpleasant symptoms of menopause include hot
flashes,
fatigue
,
anxiety
, sleep disturbance, and memory loss.

Treatments and Remedies: Benefits and Disadvantages of Each

Menopausal women are faced with many choices in terms of treatment or
remedies for these problems. Some of the treatment choices are
experimentally proven to be effective and relatively harmless, while other
options such as herbs, teas, and dietary supplements have not been
subjected to scientific experimentation and have not been proven to be
without harm.

Estrogen replacement therapy (ERT) is the often-used medically prescribed
treatment for menopausal and postmenopausal women. Although some studies
have indicated a decreased risk of CHD and osteoporosis with ERT use,
others have indicated it may increase the risk of breast
cancer
. The Women's Health Initiative, which was designed to study the
effects of ERT on the health of elderly women, stopped the ERT part of the
research in July 2002. The preliminary result of that study showed the
risk of CHD was, in fact, increased in women on ERT.

Scientific investigations have shown that physical activity, including
aerobic
and muscular strengthening exercises, not only prevent bone mineral loss,
they also help alleviate many menopausal symptoms, including the increased
percentage of body fat, abdominal-fat storage, hot flashes, fatigue, and
sleep disturbances.

Phytoestrogens
, which are present in foods such as soy, red clover, flaxseed, and other
beans and
legumes
, are natural plant estrogen-type chemicals that can help replace human
estrogen without some of the risk factors of ERT. Epidemiological
observations indicate that in some cultures where soy is a staple food,
women do not suffer from hot flashes during and

Hormone replacement pills are used by some women to reduce the
symptoms of menopause. According to the Women's Health
Initiative, women who use a combination of estrogen and the synthetic
hormone progestin increase their risk of developing breast cancer and
heart disease.

[Stephen Chernin/Getty Images. Reproduced by permission.]

after menopause. The results of human experiments designed to study the
effect of soy products on alleviating symptoms during menopause are new
and inconsistent, but promising. In addition, the
isoflavones
in soy products are strong
antioxidants
and may be effective in reducing the risk of CHD in women of menopausal
age.

Herbal
supplements promoted by the supplement industry to prevent hot flashes,
anxiety, sleep disturbances, and other symptoms of menopause have not been
scientifically studied, and since the chemical composition of these
supplements is not always known, they may contain harmful substances.
Thus, these kinds of supplements are not generally recommended for
menopausal women.

Dietary and Lifestyle Changes

Recommendations for dietary and lifestyle changes for women during
menopause are a little different from that for women in general.
Menopausal women need to eat less of foods that are high in
iron
. Because they are not menstruating, their requirement for iron is
reduced, and is thus the same as for men, about 10 milligrams per day.
This means that they need to cut down on red meat, organ meats such as
liver and kidney, and other foods high in iron. If they are taking
multivitamin and mineral supplements, ones with a low iron content are
recommended.

Water intake is emphasized in older women and men, since the thirst
sensation becomes dulled as people age. Six to eight glasses of fluid per
day are recommended for this age group. Water, fruit juices, other
nonalcoholic beverages, and fresh fruits can help provide variety in fluid
intake. In addition, an increased consumption of legumes (e.g., dried
chick peas, varieties of beans, lentils, soy and soy products) is
recommended to provide phytoestrogens and isoflavones. There are other
alternatives that are used by people around the world to reduce hot
flashes and other symptoms of menopause, including herbs such as ginseng,
black cohash, kava, and wild yam. However, there has been little
scientific data to determine the effectiveness and safety of these
supplements.

Menopausal women need to decrease their intake of total fat,
saturated fat
, and total
calories
to balance their
energy
expenditure and prevent weight gain, which is sometimes associated with
this period in a women's life. It is believed that, on average,
women gain about 1.2 pounds a year, with most of the weight gain in the
form of abdominal fat. A study done in the 1990s found that a modest
weight reduction program in premenopausal women, including
diet
and exercise, produced modest weight loss and favorable blood lipid
changes that lasted five years through the women's menopausal
period. This study (Simkin-Silverman et al.) proved that weight gain
during menopause is not only related to hormonal changes, but also to
decreased level of physical activity.

A woman's intake of dietary
fiber
must be increased during menopause to prevent
constipation
. This objective can be accomplished by following the Dietary Guidelines
for Americans, which recommend consuming six servings of whole grains and
cereals, three to five servings of vegetables, and two to four servings of
fruit per day. Exercise is also very important for all older individuals.
Thirty minutes of moderate daily exercise, such as speed walking, is
recommended. Other exercises, such as flexibility and strength training to
maintain lean muscle mass and bone density, can be very helpful if done
two to three times a week.